Perioperative digital behaviour change interventions for reducing alcohol consumption, improving dietary intake, increasing physical activity and smoking cessation: a scoping review

Abstract

Background Evidence suggests that unhealthy lifestyle behaviours are modifiable risk factors for postoperative complications. Digital behaviour change interventions (DBCIs), for instance text messaging programs and smartphone apps, have shown promise in achieving lifestyle behaviour change in a wide range of clinical populations, and it may therefore be possible to reduce postoperative complications by supporting behaviour change perioperatively using digital interventions. This scoping review was conducted in order to identify existing research done in the area of perioperative DBCIs for reducing alcohol consumption, improving dietary intake, increasing physical activity and smoking cessation. Main text This scoping review included eleven studies covering a range of surgeries: bariatric, orthopaedic, cancer, transplantation and elective surgery. The studies were both randomised controlled trials and feasibility studies and investigated a diverse set of interventions: one game, three smartphone apps, one web-based program and five text message interventions. Feasibility studies reported user acceptability and satisfaction with the behaviour change support. Engagement data showed participation rates ranged from 40 to 90%, with more participants being actively engaged early in the intervention period. In conclusion, the only full-scale randomised controlled trial (RCT), text messaging ahead of bariatric surgery did not reveal any benefits with respect to adherence to preoperative exercise advice when compared to a control group. Two of the pilot studies, one text message intervention, one game, indicated change in a positive direction with respect to alcohol and tobacco outcomes, but between group comparisons were not done due to small sample sizes. The third pilot-study, a smartphone app, found between group changes for physical activity and alcohol, but not with respect to smoking cessation outcomes. Conclusion This review found high participant satisfaction, but shows recruitment and timing-delivery issues, as well as low retention to interventions post-surgery. Small sample sizes and the use of a variety of feasibility outcome measures prevent the synthesis of results and makes generalisation difficult. Future research should focus on defining standardised outcome measures, enhancing patient engagement and improving adherence to behaviour change prior to scheduled surgery.

Digital outpatient health solutions as a vehicle to improve healthcare sustainability—a United Kingdom focused policy and practice perspective

“…One feature of digitally enabled healthcare is the ability to provide support to patients to attempt to minimise the complexity of pathways, enhance engagement with the clinical plan and prompt patients to attend investigations and appointments. This approach is supported by published data showing improved outcomes across a range of conditions including COPD (38), diabetes (39) and the perioperative journey (40). The applicability of these interventions is striking when deployed to help manage long-term conditions.…”

“…Not all patients attending clinic appointments will be employed either due to them being too young to work or being retired, additionally not all the working age population are employed. To adjust the figures accordingly the total number of appointments attended by patients between the age of 20 and 64 can be ascertained from NHS digital's hospital outpatient activity data 2020-21 (40,873,275) and then multiplied by the UK employment rate in 2021 (96.4%) to give a total of 39,401,837 appointments. Therefore, by using the adjusted attendance figures and estimated loss of GVA, it can be calculated that approximately £3.4 billion was lost from the UK economy as a direct consequence of outpatient appointments attended in 2021-2022.…”

The effect of preoperative behaviour change interventions on pre- and post-surgery health behaviours, health outcomes, and health inequalities in adults: A systematic review and meta-analyses

“…Reviews (and a recent umbrella review [26]) of prehabilitation interventions addressing health risk behaviours have been conducted. However, these have focused on just one or two health behaviours [27][28][29], have been restricted to digital interventions [30] or have focused on special clinical groups (i.e., bariatric surgery [30], patients with alcohol dependency [26]). Further, no previous reviews have sought to examine the impact of prehabilitation interventions by health inequalities.…”

Digital health coaching to improve patient preparedness for elective lower limb arthroplasty: a quality improvement project

“…In the UK, prehabilitation is commonly delivered face to face, with a focus on exercise training, nutrition and well-being 21. Very few studies have reported outcomes from a personalised, digitally delivered programme targeting multiple behaviours adapted to patient need 22. Digital interventions are being increasingly recommended to facilitate healthcare delivery and support perioperative care 23–25.…”

“…21 Very few studies have reported outcomes from a personalised, digitally delivered programme targeting multiple behaviours adapted to patient need. 22 Digital interventions are being increasingly recommended to facilitate healthcare delivery and support perioperative care. [23][24][25] They have matched face-to-face delivery in supporting behaviour change in other healthcare settings such as cardiac rehabilitation and diabetes management.…”